摘要
目的:总结分析肾移植后免疫球蛋白A肾病(IgAN)的临床病理特点和预后的关系。方法:搜集肾移植后行肾穿刺活检并诊断为IgAN的受者(研究组)34例,同时搜集初次行肾穿刺活检明确诊断为原发性IgAN的患者34例作为对照(对照组),比较两组的临床与病理特征,分析研究组临床病理特征与预后的关系。结果:研究组与对照组血肌酐分别为(158.5±75.9)与(84.8±26.8)μmol/L,尿素氮分别为(9.7±6.1)与(5.2±1.4)mmol/L,尿酸分别为(406.7±87.8)与(359.0±92.6) μmol/L,估算肾小球滤过率分别为(57.4±25.4)与(91.2±28.6)ml/min/1.73 m 2,两组相比,差异均有统计学意义( P<0.05),其余临床资料的差异均无统计学意义( P>0.05)。与对照组相比,研究组病理上肾小管萎缩/间质纤维化程度T1型比例有显著增高(50.0 %和17.6 %, P<0.05)。进一步对研究组受者的各项病理指标与预后情况进行单因素及多因素Logistic回归分析,结果表明,研究组受者的系膜增生程度对预后影响显著。 结论:移植肾IgAN受者在临床与病理特点上多数与原发性IgAN患者无明显差异;系膜增生严重的移植肾IgAN受者预后往往较差。
Objective To summarize the relationship between the clinicopathological features and prognosis of immunoglobulin A nephropathy(IgAN)after renal transplantation.Methods A total of 34 patients with IgAN after renal transplantation confirmed by renal biopsy were enrolled.And another 34 patients with primary IgAN confirmed by initial renal biopsy were adopted as controls.Clinical and pathological features of two groups were compared to explore the relationship between clinicopathological features and prognosis of allograft IgAN.Results As compared with primary IgAN group,renal function in allograft IgAN group included serum creatinine[(158.5±75.9)vs(84.8±26.8)umol/L],urea nitrogen[(9.7±6.1)vs(5.2±1.4)mmol/L],uric acid[(406.7±87.8)vs(359.0±92.6)umol/L],estimated glomerular filtration rate{(57.4±25.4)vs(91.2±28.6)[ml/(min·1.73m2)]}.All were statistically significantly higher(P<0.05)while other parameters showed no differences.Pathologically,the proportion of T1 type(50.0%vs 17.6%)of renal tubular atrophy/interstitial fibrosis was significantly higher in allograft IgAN group than control group(P<0.05).Furthermore,univariate and multivariate Logistic regression analyses were performed between various pathological parameters and prognosis in allograft IgAN patients.It indicated that the degree of mesangial hyperplasia of patients with transplanted IgAN had a significantly negative impact on the prognosis.Conclusions The clinicopathological features of patients with allograft IgAN show no difference from those of patients with primary IgAN.And among patients with allograft IgAN,those with severe mesangial hyperplasia often have a worse prognosis.
作者
张恬静
芦平凡
邓元俊
蔡阳
刘乐乐
张春江
郭一言
黎倩
朱娜
田蓓晨
韩敏
Zhang Tianjing;Lu Pingfan;Deng Yuanjun;Cai Yang;Liu Lele;Zhang Chunjiang;Guo Yiyan;Li Qian;Zhu Na;Tian Beichen;Han Min(Department of Nephrology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)
出处
《中华器官移植杂志》
CAS
北大核心
2020年第2期84-88,共5页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金(81770686,81970591)。
关键词
肾移植
IGA肾病
病理特征
预后
Kidney transplantation
IgA nephropathy
Pathological features
Prognosis
